Tag Archives: musculoskeletal

Digital Solution for Income Protection

New technologies mean disability income protection (IP) claims managers can enhance and expand the support and services they offer. Digital solutions can also be used to improve the claims experience.

TrackActive is a company that has developed an artificial intelligence-driven engagement platform that provides early, cost-effective and scalable interventions for rehabilitation and prevention of musculoskeletal conditions and other chronic disease. To find out more, I spoke with TrackActive co-founder and CEO Michael Levens.

RC: What drew you to the disability insurance business?

ML: We launched a product called TrackActive Pro. It links up patients with musculoskeletal conditions to clinics and physiotherapists. People using our service to support insurance claims suggested we go direct to insurers. They said it would reduce the friction they felt in making and processing their claims – the form filling and episodic, continuing interactions with the insurer. So, we developed a fully digital sister product called TrackActive Me.

RC: Have you encountered any challenges so far?

ML: Disability carriers don’t own the physiotherapist or the health professional; they just buy services from them. So how we get our product into the insurance value chain is very important. Insurers already have excellent claims management processes. However, these rely heavily on paper, which means we have to show that our digital offering can add value or even improve upon them.

RC: What are the benefits of TrackActive Me to the IP insurer and for the claimant?

ML: Engaging health professionals comes with a cost, and it’s continuing each time a claimant sits with one to process a claim. The quality and impact of the digitized version of our service compares very favorably; it’s as effective as going to see a health professional, and the prescribed exercises can be accessed on demand. The idea of a physiotherapist in your pocket that allows for remote monitoring is a stepping stone toward self-management. If things are working less than optimally, the user can easily opt in to seeing a health professional in person, via TrackActive Pro. Blending service and product like this is important.

See also: Putting Digital Health to Work  

RC: Must insurers think and act differently to use a digital tool?

ML: Yes, it can be difficult for insurers to visualize a digital version of an analogue process. For a start, TrackActive Me is very self-managed. While we have taken down an implementation barrier by making it simple for claimants to get and to use, we have removed some control of the process, too. Insurers can give the tool to their claimants, or a health professional can bring them on board after they have gone through their primary treatment.

RC: What is your message to IP insurers who are thinking about digital alternatives?

ML: It’s easy, really. We want to engage with companies willing to see that new digital process are not only capable but will enhance their offering. Companies that want to join the dots between the digital and the analogue. Those that have an open mind to technology and want to look at ways the current model can be enhanced.

The ideal working approach is collaboration to help the technologies of startups mature in ways that fit best with the needs of IP insurers, before plugging them into existing systems by using open application programming interfaces.

Technology will reduce the amount of manual work involved in assessing an IP claim. There are long-term benefits for insurers, as well, in the rich customer data that will be generated. Analysis of the data will provide predictive intelligence to help deliver better value and service to new claimants. It will help to anticipate claims and give focus to providing effective interventions. Ultimately, IP claims solutions delivered using AI or other digital means will save process costs that can then be passed on to customers in the form of reduced premiums. Meanwhile, a more frictionless and transparent solution to managing customers’ recovery in claim stages will significantly add to customers’ satisfaction.

Misconception That Leads to Opioids

No physician wants to create an addicted patient. In almost all cases, they simply want to mitigate patients’ pain. Good intentions with a bad strategy.

The breakdown in the system stems from a poor understanding of pain and how to diagnose and classify it correctly. In effect, you have to match the treatment to the patient’s condition, which means you need to possess a reliable method of diagnosing pain.

Human beings experience three types of pain: 1) thermal pain — quite rare and only produced in the very ill and systemically sick patients; 2) chemical or inflammatory pain — pain that is mediated through a release of chemicals at a site of injury (this pain lasts five to seven days, occurs when trauma happens and is only present in 2% to 5% of all patients in pain); and 3) mechanical pain — pain that is mediated through/by distortion or pressure on tissue (90%-plus of all pain that humans experience).

Bend your finger back as far as you can until pain is produced, and you have just experienced mechanical pain in its purest form. A bulging or herniated disc in 95% of all patients produces pain because the wall of the disc is being distorted or strained just like your finger was when it was hurting.

See also: Opioids: Invading the Workplace  

You can’t treat mechanical pain with a chemical intervention ( pills and injections). You can’t treat chemical pain with a mechanical intervention. Makes sense, right?

The problem is that we have a system built around using chemicals to manage pain and providers who receive less than two weeks of education in medical school around how to adequately assess and diagnose patients in this space.

The evidence is overwhelming. There are dozens of studies that show little influence on back or joint-related pain (less than one point on a 10-point pain scale, and that’s in only 30 % of the cohort) when using opioids, analgesics, muscle relaxants and steroids, yet every PCP and specialist in the land has them as the first stop off for MSK (musculoskeletal) patients. When the simple analgesics and muscle relaxants don’t work, then escalate to opioids.

Numerous studies show that less than 5% of patients experience any change in back pain when epidural steroids or transformational injections are used to put the medicine at the supposed source of symptom. Why are these studies struggling to find treatment effect on patients in pain with some of the best-trained examiner/physicians in the world conducting the study? It’s simple. We don’t train them to assess patients in a reliable way and to match chemical patients with chemical interventions and match mechanical patients with mechanical interventions (surgery and movement-based strategies).

See also: 6 Shocking Facts on Opioid Abuse 

90% of opioids are prescribed for back or chronic joint pain. The solution to the crisis is to teach providers to reliably sub-group patients into their appropriate pain group. Mechanical patients only get mechanical solutions, and chemically dominant or inflammatory patients get chemical treatment.

Our failure to do this has allowed us to continue to use treatment methods long ago determined to be ineffective in this population and also forces providers to become inventive. We blame the patient; we claim they are gaming the system; we think the problem is psychosomatic or a construct in their mind — when in reality we are not applying the right treatment to the right patient to the right body part at the right time.


Baseline Testing Provides a Win

According to the Bureau of Labor Statistics (BLS), the incidence of musculoskeletal injuries (MSD) cases for heavy and tractor-trailer truck drivers increased to 355.4 cases per 10,000 full-time workers in 2014, up from 322.8 in 2013. This is more than three times greater than the rate for all private sector workers.

Companies are faced with increasing exposure from MSD claims, not only from state regulations but from compliance with federal mandates that increase potential exposure for these types of injuries. (The Centers for Disease Control and Prevention (CDC) defines MSD as injuries or disorders of the muscles, nerves, tendons, joints and cartilage as well as disorders of the nerves, tendons, muscles and supporting structures – the upper and lower limbs, neck and lower back – that are caused, precipitated or exacerbated by sudden exertion or prolonged exposure to physical factors.)

Safety will always play a role in mitigating risks, but, no matter how safe an environment, an employer will always have MSD claims. In the transportation industry, the higher rates of injury can be attributed, in part, to several factors.

The nature of the work is one. Many drivers maintain a poor diet, rarely get enough sleep and are sedentary. As a result, they find themselves more susceptible to heart attacks and diabetes, as well as a myriad of strains, sprains and other musculoskeletal disorders.

Additionally, the percentage of older workers is higher in transportation than in most industries, with the Transportation Research Board estimating as many as 25% of truck drivers will be older than 65 by 2025; that translates into more severe musculoskeletal disorder claims.

So, how can a transportation company turn this around and provide a win for all parties? Let’s explore through a case study:

Marten Transport is a multi-faceted provider of transportation services offering over the road (OTR), regional, intermodal and temperature-controlled truckload services. The company has 15 operational centers and more than 3,670 employees and contractors. It needed to provide better care for MSD injuries while not accepting liability for injuries occurred outside the scope of work. Marten decided to institute the EFA Soft Tissue Management (EFA-STM) program in February 2015 to determine which injuries were work-related and which were not, as well as to provide better care.

According to Deborah Konkel, the work comp claims manager for Marten, the company uses the EFA-STM “as a fact-finding tool to help us, our employees and their medical providers better understand the nature of their injury and determine the best course of action going forward.” Under the EFA-STM program, workers are given a baseline test that is unread; after a reported injury, a second test is conducted. That data is compared with the baseline test to identify the new acute condition, distinct from any pre-existing chronic conditions.

The EFA-STM program is a paradigm shift in workers’ compensation because it provides benefits for all stakeholders by accurately separating work-related injuries from those that are not work-related and by providing objective information and, thus, better care for the work-related condition. The key question is what the physical condition of the employee was before the incident and what needs to be done to return him to pre-injury status. EFA-STM provides the required data.

To determine the benefit of the EFA-STM program, Marten’s workers’ compensation claims data from 2010-2014 was compared with claims data from 2015. The average rate of MSD injuries per 100 hires from 2010-14 was compared with the 2015 rate. The result was a 60% drop in the rate of MSD injuries per 100 hires in 2015. This translated into almost 40 fewer MSD claims in 2015. Using the 2010-14 average cost per MSD claim, the EFA-STM program yielded a direct ROI of 3.7: 1.

“Based on these results, we believe that the EFA-STM program has been a win for all parties involved and a must for companies, especially in the transportation industry” Konkel said.